How is hypertension (high blood pressure) treated in infants?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Continuous IV infusions are the most appropriate initial therapy in acutely ill infants with severe hypertension. The advantages of IV infusions are numerous; the most important advantage is the ability to quickly increase or decrease the rate of infusion to achieve the desired BP. As in patients of any age with malignant hypertension, care must be taken to avoid too rapid a reduction in BP, so as to avoid cerebral ischemia and hemorrhage. Premature infants, in particular, are already at increased risk because of the immaturity of their periventricular circulation. Because of the paucity of available data regarding the use of these agents in newborns, the choice of agent depends on the individual clinician’s experience.

In a large study that evaluated the incidence of hypertension, associated risk factors, and the use of antihypertensive drugs in the neonatal intensive care unit (NICU) setting, the risk for hypertension was found to be greatest in neonates with a high severity of illness assessment, extracorporeal membrane oxygenation (ECMO), coexisting renal disorder, and renal failure. [98] Nearly 58% of infants received antihypertensive therapy, with a median duration of 10 days, and 45% received more than one agent. The most common antihypertensive drugs were vasodilators (64.2% of hypertensive neonates), followed by ACEIs (50.8%), calcium channel blockers (24%), and alpha- and beta-blockers (18.4%). [98]

For further information, see the Medscape Drugs & Diseases article Pediatric Hypertension.


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